One Big Reason for Failure In Substance Use Treatment Programs

What’s wrong with feeling normal?

Why don’t opioid addiction programs start immediate treatment with buprenorphine (Suboxone, Subutex, Bunavail, and other forms of buprenorphine) or with naltrexone (in various forms including tablets and Vivitrol)? If treatment isn’t started with these medications, there is an 80% relapse rate after discharge.

I saw a young woman recently, let’s call her Ellen, who had been to three different treatment programs for substance use problems, of which the most serious was opioids (Oxycontin, Percocet, etc). These programs offered counseling in groups, individual therapy, education, massage, 12 step meetings, acupuncture, etc. But they did not offer the most successful part of a successful program: medication to continuously keep the brain’s opioid receptors full; or else to block these receptors. It’s like a high blood pressure program which offered low salt diet, weight loss training, exercise, relaxation training but did not include medication to reduce blood pressure: a majority of these patients would still have high blood pressure and risk stroke or heart attack. People with opioid use disorders risk death from accidental overdose, needle infections, loss of jobs, auto and other accidents, legal problems.

The most common reason given for not using buprenorphine (Suboxone) is that the person is still taking an addictive medication and hasn’t been cured. This is a misunderstanding of the word “addiction” and of the concept of “cure”. I will discuss these issues later. But even if we agree that Ellen’s success in treatment is because of a medication she cannot easily stop (i.e., she must continue to take two buprenorphine tablets every morning), now Ellen is back at work, not using drugs provided by friends or on the street, has the support of her parents and boy friend, and feels “normal”. What’s wrong with that outcome? She still requires medication and counseling and these have costs in money and time, but she feels it is a good trade off for her former life of relapses on drugs.

I am working on my next blog about the issue of self control, free will, addiction, etc. for those interested in the philosophy of treatment.